assessing liver injury tests
TRANSCRIPT
ASSESSING LIVER INJURY TESTSRay Thomason MD
Who Do We Evaluate
¨ Persistently Abnormal: AST, ALT, or Alkaline Phosphatase
¨ Persistent unexplained hepatomegaly
¨ Abnormal hepatic imaging suggestive of NAFLD
Types of Liver Injury Tests
¨Aminotransferases Enzymes (Transaminases) Alanine Aminotransferases - ALT-Aspartate Aminotransferases - AST Located in the hepatocyte thus markers for liver injury
¨Canalicular Enzymes Alkaline Phosphatase - APGamma-Glutamyl Transpeptidase - GGTLocated in the cells lining the biliary tree
Liver Tests Assessment in the General Population
Typical ALT Elevations
¨ Acute hepatitis due to a virus or drug injury other than acetaminophen: 500-2000
¨ Chronic viral hepatitis: 40-200¨ Nonalcoholic fatty liver disease: 40-150¨ Alcoholic liver disease:40-150(AST:ALT>2:10¨ Autoimmune Hepatitis: 200-1000¨ If ALT > 1000-5000: acetaminophen, ischemia,
unusual virus like herpes
Acute Hepatitis When the Usual Tests Are Negative
Acute Hepatitis When the Usual Tests Are Negative
¨ Autoimmune hepatitis ¨ Hepatitis E¨ CMV, EBV, adenovirus ¨ Diffuse Hepatic Malignancy ¨ If patient is not improving, consider:
Hepatology Consult Liver Biopsy
¨ For indeterminate cases, consider empiric trial of corticosteroids
HEPATITIS EASSESSING SERO-PREVALENCE-NHANES
HEPATITIS E CLINICAL CHARACTERISTICS
Hepatitis due to Non-Hepatotropic Viruses
Elevated Alkaline PhosphataseCommon Causes
MODALITIES TO ASSESSABNORMAL LIT
¨ Serologies¨ Imaging U/S with
doppler¨ Liver biopsy¨ FibroScan
¨ Serologies¨ Imaging-U/S, CT
SCAN, MRI-CP¨ Liver biopsy
Transaminases Cannalicular